Intravenous Therapy

Julie Ann Marie Dalisay-Uy, RN

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Intravenous Therapy
Could be continuous or intermittent and The fastest way of delivering fluids The giving of liquid substances directly medications throughout the body. into a vein.

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Introduction

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1.1 History
RA 9173: Philippine Nursing Act of 2002 ANSAP (article VI sec 28) Association of Nursing Service Administrators of the Philippines

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Nursing Standards on Intravenous Practice

- objectives
1. Serve as a guide for nurses in providing 3.2. Promote the application ofto patients, of Recognize the nursing careimplications ethico-legal principles safeunderlying the administration of IV and quality IV Therapy relativeTherapy to IV therapy

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Nursing Standards on Intravenous Practice

- Scope of Nursing Practice
 Proficient Nursing Law RA: 9173use, care,  Appropriate to infection control Adherence documentation relevant to the Perform peripheral ability in the practices  technical venipuncture, excluding   Change IV on the blood medication  Administer blood andphysicians written as  determinesite, tubing and dressings solution and  Basedadministration components maintenance and evaluationtermination of Observation and assessment of all adverse preparation, of subclavianand cutIV for  Carry out the Physicians prescription the insertion prepare, initiate, monitor and and prescribed by the of solutions, incompatibilities physician down prescription, flowforms of IVT Establish equipment. rates reactions related to IVT and initiation of of all IVT catheters. blood and therapy medications,terminate ofblood components Nursing management IVinterventions appropriate nursing patients receiving as prescribed by the physician IV therapy and peripheral/ parenteral nutrition in various set-ups
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Iv Insertion
The entry of a needle/ catheter/ cannula into a vein based on a physicians written prescription.

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Indications
 to maintain hydration  for parenteral nutrition For administration of medications For the transfusion of blood and blood products

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ContraIndications
 administration of irritant fluids or medications through peripheral access

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Key Points Prior to Initiation

 Patient assessment - duration of therapy  physicians order cannula size -- type, amount of solution - and frequency vein/ skin - type dosecondition of the of medications to be incorporated or pushed - type of solution - pts-LOC, flow rateage The activity, - dominant arm - clinical status of the pt. Page 10

Considerations for site selection

 Sclerotic andPatients activity extremities avoid using veins in the lower rest notthe  phlebitic does should in be Size of the vein should be large enough Ensure catheter tips veins not  Selectinsertion distally then movestraight, a vein that is considerably up  startto sustain sufficient blood flow the  catheter size flexion area, asselected inhibit IV flow this would not rolling and isextremity an area where it found in  veinPurpose and guidelines the selecting the dorsal preferencefor hand, portion of  inPatients type of infusion Follow the is normally splinted general forearm and antecubital fossa are suitable  selectvein clients non dominant hand the by palpation and inspection, a Cannula Assess Duration of therapy sites - Should feel patients age firm, elastic, engorged and round not hard, and prior surgery  patients diagnosis flat or bumpy.
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Guidelines in Choosing a Cannula

 -1/4 inch in lenth

 a smaller diameter  20-22 guage for most IV fluids, larger guage for viscous solutions, guage 18 for blood transfusions
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Site Selection

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Techniques to enhance vein visualization

 gravity  fist clenching  application of warm compress  application of tourniquet/ application of BP cuff  skin stimulation  translumination
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Equipment needed for Ivt

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Types and uses of IV cannula

 Butterfly/ steel winged  Over-the-needle: - Short steel needles with plastic wing - requires the additional step of needles advancing the catheter infiltrates vein - Easy to insert, but also into the easily after venipuncture small and non pliable because they are - - Should be preferred limitedbutterfly frequently used for a over time only due to increased risk for vein injury and needles because they are less likely infiltration to cause infiltration
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Types of Solutions

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Other types
- crystalloids
Solutions that contain electroytes May be used for fluid volume replacement D5IMB, D5NM, D5NR

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Other types
- colloids
Also called plasma expanders Pull fluid from the interstitial compartment into the vascular compartment used to increase the vascular volume rapidly albumin
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Intravenous Drip
The continuous infusion of fluids, with or without medications, through and IV access device.

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Intermittent Infusion
Used when a patient requires medications only at certain times and does not require additional fluid.

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Intermittent Infusion
Used when a patient requires medications only at certain times and does not require additional fluid.

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Golden Rules in Drug Administration

Administer the right drug to the right Administer the rightdrug you administer drug Administerthe right dose right the drug Administer patient theby historyis Document the rightright drugright time eachabout at thethehe Administer Take aout if the patient has any drug complete drug Teach your patient drug Find Be aware of the potential drug-drug or route receiving allergies drug food interactions

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Steps in Iv Insertion and Removal

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Problems encountered in IVT

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Extravasation

Is the accidental administration of IV infused medicinal drugs to the surrounding tissue, either by leakage or direct infusion

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Infiltration

Blanching of the skin, with pain at the site, cool to touch, decreased infusion rate

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Thrombophlebitis
Hard and cordlike vein, with tenderness at the site. Catheters placed in the veins that overlay joints are more likely to cause thrombophlebitis
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Embolism
A blood clot or other solid mass, or an air bubble delivered into the circulation via the IV site or cannula

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Infection on Site
Any break in the skin carries a risk of infection. Moisture introduced to unprotected IV sites through washing or bathing substantially increases the infection risks.
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Bruising
May occur at any time during an episode of IV therapy

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Thank you!

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